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Friday, December 09, 2016

Why Striking Doctors Are The Least Of Kenya's Health Problems

This week, the news
has understandably been dominated by the countrywide strike by the nation’s health
workers. On Monday, doctors and nurses across the land stayed at home in
protest at the government’s failure to implement a collective bargaining
agreement signed in 2013 that was meant to govern their pay and conditions of
service. The strike has thrown an already rickety health system into chaos and contributed
to the deaths of several patients and heartbreaking scenes of desperate suffering
at health centres.

It is not the first
time public health workers have walked off the job. In recent years, the health
sector has been plagued by strikes. In December 2011, hundreds of doctors marched
through Nairobi streets to demand a larger stock of drugs in hospitals, better
equipment and better pay. Three months later, in March 2012, and again in
September 2012, they again laid down their tools to demand government spend
more money on health services. Similar strikes followed in December 2013, August
2014 and August 2015.

Throughout, the main
focus of media reporting has been on the demands for better pay. Little
attention has been paid to the complaints over working conditions and the
terrible state of the health system in general. Yet the situation is dire despite,
total per capita expenditure on health (both public and private) doubling
between 2010 and 2014 and government share of that spending growing
from 36% to 61% in that period. Kenyans and their government are increasingly
spending more on healthcare. So what have we got to show for our money?

The short answer is:
not very much. As I noted more than two years ago, according to the 2013 Kenya Service
Availability and Readiness Assessment Mapping report, the country’s first
attempt to get a comprehensive picture of the health sector, less than 6 in 10
of all health facilities in the country are ready to provide the Kenya
Essential Package for Health –a sort of standardized comprehensive package of
health services. Less than half have basic amenities and while two-thirds have
half the basic equipment required, 59% do not have essential medicines. Only 2%
of facilities are providing all KEPH services required to eliminate
communicable diseases.

Further, as reported by The Star last year, the WHO Global Atlas of Health Workforce identifies
Kenya as having a “critical shortage” of healthcare workers since independence.
While the World Health Organization has set a minimum threshold of 23 doctors,
nurses and midwives per population of 10,000. Kenya’s current ratio stands at a
mere 13. Yet, according to one 2008 paper,
the irony is that there is a large pool of trained, unemployed health workers
available, but the process of recruitment is cumbersome.

Despite the government
trumpeting its free maternity program, maternal health is still in the doldrums.
In fact, Kenya is still one most dangerous countries to be pregnant and to give birth. Nearly 8,000 women die every year due to
pregnancy-related complications, while a fifth of babies don’t live to see
their fifth birthday. And then there are the scams, such as the recently exposed
Mafya House scandal where fraudsters have siphoned off up to Sh5 billion via
questionable deals or the prevalence of fake doctors.

Devolution has
undoubtedly brought health services closer to many who were previously left
out, but even here, problems abound. These range from allegations of tribe-based
hiring of doctors and questions over the efficacy of county spending plans to
the national government foisting medical equipment on reluctant counties
lacking the capacity to utilize it. There are also massive inequalities in
access to healthcare facilities and in staffing which manifest in statistics
such as a third of counties being responsible for 97 percent of all maternal
deaths.

But perhaps no other
area is as neglected as care for the mentally ill. When about 100 patients reportedly
“escaped” from the Mathari Mental Hospital on Monday, the media dutifully
reported it as a consequence of the health workers’ strike. Yet earlier this
year, a report
in the Daily Nation indicated that the country’s sole referral hospital for
psychiatric care was packed to the brim with patients, some of whom had been
sent there by the courts for “failing to understand English, or Kiswahili … or
for domestic issues that had nothing to do with mental illnesses.”

Worse, the conditions
inside the hospital are appalling, with patients drugged into a stupor, abused,
denied food and other basic necessities. In 2013 when 40 patients again “escaped”
following a riot at the facility, the Nation reported
“it was a case of hunger, abuse, lack of basic services and a fight for
survival.” This deplorable state of affairs is perhaps not surprising when one
considers that only 0.5% of funds earmarked for health is spent on mental health.
This is despite the fact that, according to a 2011 CNN report, “the government’s own figures show that one-quarter of all
patients going to hospitals or clinics complain of mental health issues.”

The fact is, even
before the current strike, Kenya’s health sector was already in a state of
crisis. It will not be cures by appeals to patriotism and fellow feeling or even
solely by paying our doctors better. Rather than merely addressing the symptoms
of decay, Kenya needs a sober examination and diagnosis of the underlying systemic
and structural illness afflicting its health system. Then a similarly credible
set of proposals to cure it. The campaigns that are underway for next year’s
elections provide the perfect opportunity for Kenyan media and society to force
the political class to do both. The question is: Will we take that opportunity?
Or will we continue acquiescing to management of health by crisis?

3 comments:

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